Hi, this is Nick Webb and welcome to another episode of The Healthcare Cure. You know, today is kind of an exciting program for us. It’s our first video of the podcast we wanted to add this to our V log to be able to make it available to those who want to be able to have the element of video within the podcast. So welcome to our video watchers and, and welcome back our podcast listeners.

Today we’re going to talk about something that is that I’m very, very passionate about and that’s digital health generically. One of the areas that that fascinates me is the area of continuous patient monitoring. And I know that a lot of people, they hear that and they immediately start thinking how Orwellian it would be to be monitored 24 hours a day. But I think as we start to look at the incredible life saving benefits of continuous patient monitoring, we’ll begin to we’ll begin to realize that the benefits are far greater. And I always like to give the example of Amazon. Just a few decades ago, there were many experts, financial analysts and business analysts that ensured that Amazon was going to fail because nobody would ever risk putting their credit card on the internet. Well, it worked out okay for Amazon. And my point is, is that today, there is a general concern that your data, your health data could be made available in some way that could be injurious to a patient. But with blockchain and other encryption technologies, in combination with many new other opportunities to to really protect that data. I sense that that really will not be a problem. Also, the exciting part of this is that patients will actually be able to monetize their data by selling their data to insurance companies or drug companies and the like. So continuous monitoring is definitely going to happen. I believe that that continuous monitoring will be an in ear technology because we’re moving towards the Internet of the voice, right? The idea of typing something is you know, so 2020. What we want to do is to be able to communicate using normal human language. And that’s why Amazon is embedding Alexa in just about everything from cars to telephone, I mean televisions and the list goes on and on. Right? So the Internet of the voice is where we want to go. And that’s why we need to have that sensor technology in the ear so we can provide bi directional patient communication. It’s also a great place to be able to get blood pressure now with new sensor technology, core body temperature, and this whole new body of study around the concept of head movement AI, we’re beginning to realize that head movement is the ultimate place to be able to get total body movement when compared to the wrist which provides erroneous and and incomplete data.

So at any rate, what today what we’re going to talk about is hospitals and clinics, how we can look at these hospitals and clinics in a way that allows us to get data that we can use to improve safety, improve efficacy, improve patient flow, improve everything. Now, one of the things that you have to do if you want to fix this problem, and I recently I spoke at the chime event, and I made a proclamation at that event in front of thousands of people, that hospitals are technology organizations that happen to deliver safe and efficacious care. And a lot of people send me emails saying, ‘You monster, how could you say that hospitals are nothing more than technology companies?’ Well, the truth of the matter is, is that of course we need good caregivers and that’s the centerpiece of a hospital or clinic. But in today’s with the opportunities that we have today, it would be negligent not to leverage these different disparate data sets to be able to improve the quality and safety of patient care plain and simple. And that will continue. So the process of doing this right from my perspective is that you go on a data safari, and you crawl around your enterprise to find out where data lives. And then the goal is to connect a hose to that data to a central means of aggregation, so that you can then look at the data, sanitize it for inaccuracy, and then move it into AI to where the learning machine understands the starts to understand the meaning of these disparate data signals. So it can then provide a variety of serious scenarios and reportable data that can be reported out reported out through executive dashboards and graphic dashboards and the like.

And so today we have the great honor of having Jeff Terry, who is also going to be one of our cast members is a cast member in the Fixing Healthcare documentary. And we’re going to we’re going to learn about what GE Healthcare is doing to be able to impact the quality and safety of patient care through something that I’m just so excited about. And that is command centers. And these command centers are having an incredible impact. And my sense is you won’t be able to go to a small community hospital that doesn’t have some form of a command center in order to ensure the safety and patient flow of their hospital. So without further ado, I of course today have Dr. Ray Power with me. He’ll be asking questions along with myself on and kind of really grilling Jeff on what we can expect the future looks like and how we’re going to fix healthcare using these great tools. So Jeff, tell us a little bit about yourself and how these data dashboards are going to change the world.

Well, it’s important work. Thank you very much. It’s great to be with you and hello to the audience. Jeff Terry, I founded and lead this command center work at GE which is if you think about a command center is this place with massive situational awareness right NASA mission control the movie Apollo 13. But now like everything else in our life, take that information that real time information and push it everywhere, push it everywhere that it’s useful on smartphones and tablets and PCs. And, you know, to your point, hopefully just in our ear pretty soon, and we’re interacting with that information through our voice. But the real magic of command centers, this idea of marshaling all healthcare resources, meaning all the different types of providers, all the different types of technology, marshaling all those resources for the best outcomes and the best efficiency for every patient right now. And that really starts with or the thing that has made that so difficult, in addition to just the complexity of healthcare, is getting all the data organized. There’s so much data in so many places being constantly created, and to connect that hose and make sense of it. As you mentioned in your intro, it’s very difficult and that’s what we’re trying to do with and for caregivers.

So what does the command center look like? I mean, I’ve had the great honor of taking a look at some of your, your research and some of your images of the various command centers and as a technological geek, I mean, this is like, unbelievably exciting, right? And so what does it typically look like? And what are most hospitals really looking at in their command center?

Yeah, absolutely. Well, like you said, so today, you know, it’s a relatively new concept. The first was at Johns Hopkins four years ago, you know, I think four years from now most big hospitals, health systems, small hospitals, clinics beyond hospitals will have this command center concept. You know, certainly think of the room as that NASA mission control with a bunch of different type of expertise, co located to look out for patients in real time, with massive situational awareness about who’s were waiting for what, when we if the information can help bring it into focus, so if we’re thinking about every patient that presents, they may have a chief complaint. But of course, they’ll have a medical history. They may have secondary complaints. The medical staff will have protocols they’ve designed for all of that. How do we make sure that the patient it gets the best care according to those protocols? Well, the information can help when we can pull all that together, use the AI to look for the patterns to find the variation to what we would expect to happen, weave all that together, and serve it up to the right user. And we can talk about you know who the right user is, but serve it up to the right person in a way that is no more difficult than Uber. So under the hood, we have all this massive revolutionary technology. But like everything else in our lives to be useful, it has to be easy to use and fast. And that’s another big part of this making it easy for the caregiver to put that information to work for a patient right now, right? Like we want patient care to be a human to human interaction with compassion and patient centered. And to do that, we have to take the caregivers eyes off of the screen and let them be back on the patient. So that means speed and ease of use, even while at the same time massive horsepower, that all has to come together. And that’s what command centers are about.

Ray, I know you’ve probably got some questions.

Yeah, I would be delighted to talk to you today, Jeff. And I love your mission, state way to say that you’re helping patients by serving caregivers. And from my point of view as a family physician myself, the trust that exists between the caregiver and their patients will really enable this technology to succeed. And as patients become more familiar with it, and indeed, as we, in our training, as physicians of the future, become more familiar with the data that’s not already within our EHR, but the extra data coming from the 24/7 perpetual touch, then we’re really hitting a sweet spot and. No, no time like the pandemic we’ve just gone through over the last three to four months where if we did have that data available to us the actions that the blood pressure, the temperature, we’re spiritually right sleep patterns, it would have had a huge difference to the intensity and penetration of the pandemic. So I really believe that this is the way forward because as physicians, you I think you got a one we’re so bogged down and admin and at least one third of our day is faced with doing admin tasks, which really aren’t, there’s a significant opportunity costs associated with those. So from my question, Jeff would be to, to just to see how your approach say Johns Hopkins is a perfect example. How can that then be an integrated approach between what’s happening in an intensive environment to what’s happening in the community and can there be joined up thinking between those two systems because that really will then create that ongoing care provision.

Yeah, absolutely Ray it’s both sides of it. It’s the in the acute environment and in the not in the rest of our lives and most of our lives so that that takes a lot of forms in the outside of the hospital. It can be using the command center these real time information tools to get patients to the best access point for their care if you think in in a community setting. There are services that overlap so you can call a high dependency line. You can call a suicide prevention line you can call different services and sometimes you might wait for one and the patient doesn’t realize another service can offer me what I need right now instead of waiting so it can be as simple as connecting those dots so it’s joined up and they get access fast. Can also the about smooth handoffs from the home and into the hospital and from the hospital either back to the home or to the post acute setting. We do a lot of work around that to help make those transitions smooth, if a patient needs to be on a ventilator in a care home well, that there’s a whole series of coordination activities that have to happen to make that smooth. And like everything else, you know, it’s complicated and hard to get that just right and the information tools, close a lot of those gaps. You know, certainly other examples, helping to make sure patients have the medical equipment they need at home, helping get patients connected with their care team and the family and support network that most people have. So that the family and support network is kind of dialed into the care plan. Information tools are beginning command center tools are helping with that. So no doubt in the acute setting and everywhere else.

I love the fact that it’s all about teamwork. So you’ve got your professionals, health professionals, administer professionals head to head, who are then what I like, is that patient centered medical home model where you have this integrated approach between the clinical and the non clinical team. And what you’re doing through this technology is to enable that to function return real time in a proactive rather than reactive model. And that’s the thesis of our documentary is, I suppose, a very brave statement to fix healthcare just like in the recent Harvard Business Review case study, which was at the end of April, and they’re absolutely describing how we need to be moving from sick care to assuring health and that is the mindset see change that your technology will will enable and I am I think it’s got fantastic facility use across the board and I’m sure you’re finding that it’s becoming very popular outside of the United States as well. I know you have services in the UK and here in Ireland and I’m sure elsewhere in the world also, Jeff, would that be the case?

It is. Yeah. I think that the challenge and the desire to get to wellcare assuring health, I think, is a common goal. And of course, the challenge is, how do you do that? Right? And certainly, so we’re doing this work in the US and Canada and the UK, we’re doing this work in the Netherlands and in Dubai and in Saudi Arabia. And we’re, you know, we’re, I think you’ll see, you know, most countries in the world over the next couple of years.

You know, what’s interesting for me in my work as a management consultant in healthcare, we do a thing called a readiness assessment, we take a look to find out kind of where they are, right. And at the end of my analysis, my audit, it’s almost always the same discussion. You guys have no bloody idea what’s going on here, do you? Right? There’s, I mean, I mean that with all due respect, right that there is they’re finding unbelievable things once they start the process of going on data safaris, understanding how to grab that data and do something with it. I mean, I think anybody, any lay person could walk into an emergency department with an envelope, and on the back of the envelope put together a plan that would significantly improve that really bad setup, right. And, and so the problem is, is that we really need to develop it. You know, many hospitals have developed Six Sigma lean methodologies. They’ve developed Scrum methodologies, they’ve started to develop patient throughput analysis and optimization. And, you know, as a Six Sigma Black Belt myself, I can tell you, that’s cool and all but the problem is, is that you really can’t optimize things that you do not understand.

And the other thing that’s really interesting to me is they built these incredible bodies of knowledge around optimization, and they’re optimizing things that should be destroyed. Right? They’re fixing things that should not be fixed they should be. In fact, that’s what disruption is all about displacing lame, broken things with things that make sense. And one thing that’s really exciting right now, from my perspective, as an innovator is that, you know, there is a thing called discretionary innovation. That means we get to sit back in our corner office, and decide what we want to innovate around. And that’s possible in a time of a stable economy and in a time where you don’t have massive, massive disruptive change. But as a result of the C19 economy, organizations are now experiencing what I call forced innovation. And forced innovation means Yikes, we actually have to be willing to set aside what I call legacy latency where we try to be late by holding tight to legacy. And and that’s really unfortunate. We have scripts that will be in the documentary film an amazing organization. And they went from really no telemedicine consults to where I believe they’re at about 3500 telemedicine consults a day. And what they begin to realize is is that, you know, for a lot of organizations, they were just waiting for the next shoe to drop, and it did and it’s called COVID-19. Right. So I think the biggest problem for most organizations as it relates to adopting your technology will be something very simple. Are you willing to continue your legacy latency, meaning that your commitment to hanging on to what was or are you willing to be an innovator and to one of the challenges that’s really interesting is a lot of people don’t want to know the data from the command center, right? Because they’re afraid that you know that it could be it could illuminate some, you know, some problems that that they have. And so it takes bravery. It takes a future mindset. But ultimately, it takes a commitment to quality patient care to adopt technologies that leverage the superpower of aggregating data and reporting it out so we can be better, right?

I think that’s right. I think there’s also scar tissue from some of them where they’ve tried different improvement methods that haven’t worked out. So they get a bit of fatigue. And so we have to help people. We have to craft our work to really help and help people see that it really is helping and obviously that’s the work that we do every day. I you know, I always come back to the problem, the complexity of the of the healthcare enterprise, I, one of the things that we’ll look at is how many pathways are there through this hospital in a year in a pathway to find a CD to this unit to that unit, to home ed to ICU to home, whatever. And we’ll find you know, your typical 500-600 bed hospital there’ll be six or seven thousand different pathways per year that patients traverse with. Obviously dozens of different types of caregivers involved. So well any one caregiver may be optimizing for a certain type patient or a certain setting of care, optimizing that enterprise is just breathtakingly difficult. But that’s that’s the challenge. And it’s also the opportunity because when we do bring order to that chaos, the impact for the patient and the efficiency of the system is massive. And I boy, watching what and helping these health systems react to COVID was inspiring I 100x increase in telemedicine visits, you know, achieved in weeks, a whole new processes for checking in patients and to your point, it really shows the latent ability that there is to innovate when we can focus minds.

Absolutely. You said something there, Jeff, which really resonated with me putting myself in our patient’s shoes because you said certain types of patients. And if through this journey with the kind of center and all of that data aggregation, if we’re able to consider the behavior types and the traits over patients and do some psychographic segmentation of our patients, then I as us being the care givers will be able to translate that data back to their patients in a way that would say my doctor gets me because those who would be doing the triathlons, they’re looking for a lot more scientific data around their vo to Max’s and other data measurements than those who perhaps would have a more and dependent relationship with their provider. If we’re able to do the quantitative that you’re describing, with the quantitative which accommodates the behavior traits of our patients, and molds those together, that’s going to have a multiplier effect that our patients are going to go wow. Because they really feel that their personality has been considered the journey as well.

Well, amen. Yeah, I mean, you see a generational factors with you know, that, you know, that the generation that’s older generations now have less familiarity with digital tools, the newer generation, the younger generations, just expect them of course, it should come to me in this app way that I can process in seconds. You know, was that I heard someone say if you use a Fitbit, you probably don’t need a Fitbit right? You know, you’re sort of self selecting. But yeah, but we have to we have to harness all of that. And I think as it relates to the the use of information, there’s such an opportunity to help caregivers. And that’s a huge body of work that will continue for a decade. But then to your point, the next body of work is kind of patient facing. And I think that’s even less mature than the caregiver facing work is, but it’s all. It’s all happening and will continue to play out.

Now, one of the things that, you know, we see and you know, I wrote a book a few years back called What Customers Crave. And I realized there were three things that the best hospitals and clinics are doing that are really impacting the quality of the of the patient experience, but I prefer to call the constituent experience. First of all, they’re using personification. And they’re identifying a range of personas, not based on psycho demographics, or economic demographics, or any of those kinds of things which really don’t matter. They’re looking at patients from the perspective of what they hate and what they love. And when you can develop hate love personification, you can be really able to create amazing, amazing experiences. The other thing that they’re doing is they’re identifying the five touch points that patients are experiencing is the pre touch moment when they’re looking for, they’re searching for, you know, what is this rash mean? Right? And they find us right so that what Google calls the micro mobile moments because the overwhelming majority of a patient’s journey begins with a with a web search. And typically that’s on mobile, to the first touch to the core touch to the last touch moment into the way in which hospitals and clinics stay in touch. In fact, when you take a look at most industries, they do a really good job of customer journey mapping. They do a really good job of pays our customer consumer personification, and they also develop blended experiences, extended experiences that aren’t either or they’re a combination of the digital experience with a physical experience, and that ultimately is where we have to go. One of the things we talked about the film is the amazing control that consumers have taken. They’ve seized control of many different aspects of healthcare. They’ve seized control of orthodontics through Smile Direct Club. They’ve seized control of audiology through Eargo. They’ve seized control of optometry through things like Opternative. They want low friction. And I think one of the areas of command centers is the ability to find out what is the friction, which is usually time, you know, how many, how many efforts, how many times do they have to fill out a form? How long do they have to wait? How much are we going to punish these poor individuals, right. And the best hospitals and clinics have been very, very thoughtful about eliminating friction, improving the personification of how they identify their patients. And then also thoughtfully creating journey maps. And I think that command centers and command and there’s a range of tools that can do a really good job to be able to help that happen.

And then, you know, we worked with the health system, which been more than five years ago, maybe to help them think about what was the experience they wanted their patients to have and it came down to this idea of we were expecting you. They wanted when the time the patient arrived for acute care, boy that these people know me. And they were expecting me. And I thought that was a great, a great thought.

Yeah. You know, there are hospitals now that have eliminated and clinics that are eliminating completely waiting rooms. Yes, it was written a few years back called the doctor, the patient will see you now. That’s right. And I think that is emblematic of the changes that we have to make. Well, listen Jeff. I’m sorry, go ahead.

As you say, in those in those forums that we all fill out that, you know, people are trying to lean those out, but boy, we got a long way to go there. I think a good example where the command center comes into play is where the worst thing that can happen to the patient is they fill out the form, and then the information that was on the form isn’t used. So what do you mean, you’re giving me the wrong, I told you that four times, and you still didn’t, you still didn’t hear it. And that’s where a perfect example of where the command center can constantly take all that information and then constantly apply it, as opposed to just putting it into a black hole.

Yeah, the the systems that they use, and I don’t want to mention the name of the system, but there is a popular system that you use within hospitals. I’ll give you an example. I did some consulting for one of the largest health systems in the country. And they subscribe to these patients surveys, they spent $4 million a year getting patient data. And there was two problems. Number one, the rate of the data was all wrong. And number two, they never looked at it. It literally sat in a binder in somebody’s office in the basement. And you know, here’s the other problem. There’s a famous study, a focus group study that was done by Sony, where when they first came out with the Sony boombox, they brought a bunch of millennials in and they said, We just need 10 minutes of your time here is the really super cool black boombox. And here’s the really super cool yellow boombox. Now, how many of you want the black boombox 10% said they wanted the black. How many of you want the cool yellow boombox 90% in the room in the focus group said we want the yellow. And then the moderator said thank you for coming. And as a reward for your contribution today, please grab your Sony boombox in the way out. As they were packing up, they begin to realize that 90% the exact opposite of the people in the focus group, grab the black boombox. So the problem is, is that it’s not about asking them it’s about you know, well and and you have to innovate, right? It’s you don’t have to ask a patient if they want to wait for three hours in the emergency department to be seen. You don’t have to ask them if there is ways in which that they can truncate that pain. We know it and Steve Jobs understood his customers so well that he invented things that they didn’t even know they needed to have. That’s where our customer experience our constituent innovation comes in. And I think that’s the next big wave in healthcare as it relates to patient experience.

Yeah, absolutely. I couldn’t agree more. And Jeff, you said it yourself. It’s about listening to our patients. And if we do that successfully, you actually get the clinical diagnosis much more anyway, because 90% of the time, it’s the history that will tell you so we need time and what you’re going to deliver us through your enabling technology is that time to create the beauty of the relationship between the caregiver and their patients. And that’s why we’re all in this vocational healthcare industry. It’s what attracts us to it.

Absolutely.

Yeah. What we talked about in the film is there are four things that doctors and patients need. Number one, they need more time, that you just you can’t make up for that the caregiver and the patient need and want more time together. The second thing that we need is better data. Some studies suggest that 50% of primary care visits result in a false diagnosis. Is it because they’re not learned experts? No, they don’t have enough data. So I think that’s where continuous patient monitoring better ways to be able to get patient data is absolutely critical.

In harvesting the data, right? That’s it so much of our work. You could describe it in many ways, but so much of it is harvesting all the data that’s out there and serving it up fast enough that the caregiver can use it and you know, fast enough as measured in seconds, it can’t be, you know, 10 mouse clicks and wait 15 seconds between each one, it’s got to be right now. And when we do that, and we combine that with the brainpower of our learned experts, we tend to get a good outcome.

That’s, that’s so true. And we we hope to showcase the importance of data. Because at the end of the day, what we really want to do here is we really want to offer up a prescription for fixing healthcare. And we know that solutions like yours are the key to make that happen. Well, guys, we’re out of time. I appreciate so much everybody taking the time to talk about command centers and hospitals and clinics, I think it’s so cool. Well, you know, as an Apollo NASA freak, I love all things command center, right. But in general, I think that our ability to understand our operations, the way in which we engage and serve patients in a safe and efficacious way is so critical. The data is the lane around the enterprise, it’s there. We have to be willing to fetch it, connect to it, understand it and act upon it, we do that we can have an incredible impact in the way in which we serve patients. Guys, thanks again for your willingness to share your great insights today. And, and Ray, thanks so much for always, your contribution I lo-

It’s just my last thought in my brain is just like command center and just as we’ve discussed, it’s the same as like a listening hub. But it’s it’s listening to science, and it’s listening to humanity. And it’s bringing those both together and unifying them. And that’s a beautiful thing.

I think it is. And I think the key is, is that we have to listen from the perspective of how can we serve? Right? How can we serve? I think, unfortunately, so many organizations look at data from a very hedonistic and self serving perspective, how can we maximize profit? How can we, how can we get patients through this place quicker? How can we reduce and manage risk? I think the only caveat to this is it has to be done. From the perspective of humanism, it has to be how can we serve we take that perspective than data is good. But data like any tool can be used in a way that doesn’t serve the patient. And I think that would be unfortunate

And serves the caregiver. Thought for me in real time, you know, during the game not in the locker room after the game to say what, you know, what could we have done differently yesterday, but right now for the patient in front of me when it’s useful?

Absolutely. Well, that’s absolutely right. And I again, we’re so excited to get your story and the great work you’re doing in the film. And I’m so glad that our paths crossed and that you’ll be able to help explain to our audience how we can use data, data aggregation or reporting as a way to really fix healthcare. Thanks again, guys for your time today. I really appreciate it. Thank you.


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